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Cerebral spinal fluid (CSF) shunts are the main treatment for hydrocephalus. They divert excess CSF from the ventricular system to the abdominal, pleural, or intravascular space where it is absorbed. The shunt valve regulates flow based on intracranial pressure (ICP) to maintain a physiologically stable and safe ICP. Shunt malfunction is difficult to detect, life-threatening and common. The present study demonstrates that snap-though buckling (STB) shells can be transformed into pressure-relief valves that act in the normal physiological range of ICP. Three different shell designs in this preliminary experiment were found to have opening and closing pressures that fall within the physiologically normal range of ICP of 6 to 25 cm H2O. Furthermore, these STB shells demonstrate a valve actuation that is visible by ultrasound and have an implantable form-factor that is similar to currently available shunt valves. The unique characteristics of STB shell valves have potential clinical applications for shunt monitoring using ultrasound imaging and can be fabricated from antibiotic-impregnated materials to mitigate shunt infection. These characteristics make STB valves attractive for future use in cerebral shunt systems.

Carcinomas showing thymic-like differentiation (CASTLE tumors) are very rare entities requiring an individualized therapeutic plan. This report describes a case of reconstruction of the innominate artery after radical resection of the tumor in a patient in whom a custom-made cerebral shunt was used for continuous cerebral perfusion.

Purpose Correct placement of the ventricle catheter directly influences the function of cerebral shunt systems. The incidence of proximal catheter misplacement reaches up to 45%. To avoid misplacements and revisions a new intra-catheter endoscope for precise ventricle catheter placement in children was evaluated. Methods The semi-rigid ShuntScope (Karl Storz GmbH & Co.KG, Tuttlingen, Germany) with an outer diameter of 1.0 mm and an image resolution of 10,000 pixels was used in a series of 27 children and adolescents (18 males, 9 females, age range 2 months–18 years). Indications included catheter placement in aqueductal stenting (n = 4), first time shunt placement (n = 5), burr hole reservoir insertion (n = 4), catheter placement after endoscopic procedures (n = 7) and revision surgery of the ventricle catheter (n = 7). Results ShuntScope guided precise catheter placement was achieved in 26 of 27 patients. In one case of aqueductal stenting, the procedure had to be abandoned. One single wound healing problem was noted as a complications. Intraventricular image quality was always sufficient to recognize the anatomical structures. In case of catheter removal, it was helpful to identify adherent vessels or membranes. Penetration of small adhesions or thin membranes was feasible. Postoperative imaging studies demonstrated catheter tip placements analogous to the intraoperative findings. Conclusions Misplacements of shunt catheters are completely avoidable with the presented intra-catheter technique including slit ventricles or even aqueductal stenting. Potential complications can be avoided during revision surgery. The implementation of the ShuntScope is recommended in pediatric neurosurgery.

Purpose The purpose of this study is to describe an intravessel cerebral shunt that allows perfusion of both cerebral hemispheres through the axillary artery. Description The cerebral shunt is a 10-cm to 12-cm long cannula with a lumen for blood perfusion and two balloons, one at each distal end. The proximal ballon is adapted for retaining the proximal end of the catheter in the innominate artery; the second inflatable balloon is adapted for retaining the distal end of the catheter into the left common carotid artery. Evaluation Three consecutive patients received bilateral brain perfusion through the right axillary artery with the use of this cerebral shunt. Conclusions The cerebral shunt allowed bilateral cerebral perfusion as verified with cerebral oxymetry in the absence of any evident neurologic dysfunction.

In The Lancet, Turgay Saritas and colleagues report a case with the valuable reminder that chronic low-grade infection of an implanted device can lead to glomerulonephritis. This complication was fi rst described 50 years ago in patients with implanted cerebral shunts, so-called shunt nephritis, but in this case was associated with a newer and increasingly widely used implanted device, the left ventricular assist device (LVAD). Such glomerulonephritis can cause relentless progressive kidney failure, even with antibiotic therapy, especially if circumstances do not allow device removal. There is, of course, nothing specifi c about the cerebral shunt; it was simply the most widely used device needing long-term placement in the circulation at the time of the fi rst report. Any indwelling artifi cial device is prone to biofi lm formation and consequent infection and recurrent bacteraemia, so chronic low-grade infection is hardly unexpected in view of the many challenges such devices pose for immunity. It is interesting to consider how the wide variety of clinical consequences from infection of such a device might refl ect diff erences in host immunity and the infecting organism. Why do some patients get overt septicaemia, whereas others develop endocarditis or abscesses in bone or soft tissues? Yet others, such as in this case, do not develop clinically apparent infection, but a chronic antibody response to the bacteraemia that is insuffi cient to clear bacterial antigens, followed by tissue injury that probably results from the formation and deposition of antigen-antibody complexes. Case Report Comment Glomerulonephritis from a chronically infected implanted device